Dr Kathleen McLoughlin, National End of Life Audit and Review Co-ordinator, The Irish Hospice Foundation, reflects on the 3rd International Public Health and Palliative Care Conference held in Ireland on 25-27 April 2013

Dr Kathleen McLoughlin

Last month I attended the 3rd International Public Health and Palliative Care Conference organised by Milford Care Centre and The University of Limerick in association with The Irish Hospice Foundation, in Limerick, Ireland. Over three and a half days delegates reflected on the question: Death, dying, loss and care: Social experience or medical event? Inspiring presentations from Professor Cillian Twomey and Dr Bruce Rumbold highlighted that it is indeed both. I was inspired by the stories told through the films about “Bill” and those told by Dr Frank Brennan from his practice. I was educated in the theory of ‘Health Promoting Palliative Care’ by Professor Allan Kellehear, challenged to think differently about practice by Nigel Hartley and about research by Professor Luc Deliens. I was immersed in the subject of death, dying, loss and care from the moment I woke up until the time I went to sleep. The speakers made me laugh, made me cry, made me irritated and even angry. Most importantly, they made me think. Academics and practitioners challenged us all to see things differently… to see death as part of life. They tempted us to try a new way.

On the final day of the conference, death touched my life. And yes, this is a true story ­– not an Irish yarn! Our goldfish that we had had for four and a half years died on Saturday morning. I went into the dining room and spotted the goldfish lying at the bottom of the

The goldfish bowl: Goldie and Silver fish spent years together in that bowl

bowl. He was struggling to breathe, he could barely move, obviously weak.

So what did I do? The complete opposite of everything we had considered during the conference. I picked up the bowl and rushed the fish into the kitchen and threw him into a new bowl (with his lifelong partner) into ice cold water – literally turning their world upside down – my kitchen was ER (Emergency Room) for goldfish.

Having thrown the fish into the water and provided them with oxygen and a new environment, I put them back in their usual place. I was satisfied and proud that I had done something heroic to save his life. I could cure him.

Ten minutes later, the fish was dead.

Fear and panic started to rise. “Why?” I hear you shout…”it’s just a bloody goldfish – you’re nuts!” True – it didn’t really matter to me – it’s not my problem.

Luke

But it’s not my goldfish… it belongs to Luke, my six-year-old son.

Luke was staying with my parents while I was at the conference, and when he came home, it would be to a dead goldfish. Luke would be devastated – this was his goldfish. What could I do? I know, I’d go to Limerick, buy a new goldfish and pop it in the bowl before he got home and he’d never know a thing.

I looked into the bowl and there was Goldie’s friend, Silver fish. They’d spent years together in that bowl. Now, I don’t know if goldfish grieve or even notice when their little friend dies so I throw him some food and start banging on the glass, urging him to eat. Poking and prodding, working on the bereaved fish.

On the way to the conference I began to think about the morning I had had. What was I thinking of? For three and a half days and the past 12 years I have been telling the world and hearing the words that we need to be open about death, dying, loss and care. We need to have a positive attitude and everything will be ok. We need more awareness. Yet in 10 minutes I had just about broken every principle discussed at the conference, every value of palliative care and every mantra of public health approaches in this field of end of life care. It took just 10 minutes.

I had been unwilling to recognise death as a part of life as many of the speakers had encouraged.

I’d moved a dying fish from his natural habitat, forcing him, and his lifelong soul mate to accept the emergency measures I inflicted on them to make me feel better.

I gave no consideration to the health and wellbeing of the fish’s soul mate, prodding and poking her – working on her and not with her.

I had decided to deny the truth and tell my six-year-old son a pack of lies to make things ok and to ensure that I protected him from death.

I had denied that I too was actually a little sad that Goldie was dead.

If I reacted like this to the death of a goldfish – God only knows what will happen when I am faced with the end of life care of my parents, my husband or, god forbid, my children?

Death, dying, loss and care is a complex area. It can be difficult to apply theory and practice at these difficult times. Milford Care Centre’s work is underpinned by Mother Mary Potter, the foundress of the Little Company of Mary, who said that we all have the power within us to do good and without a vision, we perish. We, in health- promoting palliative care, have a vision and hopefully the conference last month will give us the inspiration we need to make a difference when it matters. My wish for participants who attended, is that we take just one idea, example or action from the conference and use it to reach out to just one other person between now and the 4th International Conference in 2015, to be hosted in the UK.

P.S Yes, I told Luke about the fish. He was sad. He cried. He said, “I loved that fish.” We buried him and planted a strawberry plant to mark his grave. And everyone is fine…

8 Responses to Death of a goldfish: Social experience or medical event?

Dear Dr Kathleen McLoughlin
I am analyzing Your text, Your very interesting text wherein the Sensitive and Active Reader finds a rich space of meditation: ‘Social experience or medical event? … highlighted that it is indeed both.’ Your detailed description is the symbol of That Union, because ‘Social experience’ contains the ‘medical event’, as well as ‘ medical event’ is contained in ‘ the social experience’. In Latin the word ‘mederi’, the source of medical, means h e a l. Etymologically ‘ health’ and ‘heal’ mean the state of being w h o l e. You can imagine the fullness of meaning of w h o l e. The wholeness of Human Being living in the World. And in this Wholeness there is Love and Pain/Sorrow.
Since 2010, I have been studying Pain in PreverbalChildren. On the 17th October 2010, my Little Nephew Giampaolo died, at 19 months. On the 8th March 2010, at 12 months he was diagnosticated the AcuteLymphoblasticLeukemia. His pain was great. So great. He underwent only the PharmacologicalCare. Giampaolino Never spoke because His great pain faded His will of wording. I began many studies for Him in the field of the Non-PharmacologicalCare in Preverbal Age: the power of language, of sign, of gesture, of pain. All What I am doing Is to His Memory in order to give That to All the OtherPreverbalOncologicChildren in the World. Luisella Magnani

Hi Luisella, Thank you for reading the article and I am sorry to hear that your nephew Giampaolo died. Your work sounds very interesting in the field of pain assessment for children at the non-verbal stage of development. Have you published or presented any of your findings yet? I am sure that most, if not all, of the conference participants agree that death, dying, loss and care is a combination of both social and medical experience – and the holistic approach that you speak of is at the heart of good palliative care.

Dear Kathy, I thank You for the Fullness of Your words. The Fullness of words dictates the Concreteness of their meaning. Yes, Kathy, ‘ the holistic approach is the heart of good palliative care’. When a PreverbalChild feels this Wholeness devoted-and-dedicated to Him, His mood, His thought, His behaviour b e c o m e New. Because he feels that New times and spaces are thought, created and practised Just for Him, for His Mind-and-Body.
Kathy, on my website, http://www.luisellamagnani.it, just today one of my recent articles has been published, in the section OncologicPsychoLinguistics. It concerns the Best Practice of the PreverbalPediatricEmergenceDelirium Scale, the PPED Scale, the Scale I wrote and published on my website, months ago.
I want to give as a Gift all my Studies in Memory of my Little Giampaolo to All The Other PreverbalOncologicChildren in Italy, in Europe, in the World.
Sincerely Luisella Magnani